Adult Ed Student Information and ReleaseNeed help? Stop. Go back. Call or email us! Step 1 of 2 0% Name* First Last Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* Enter Email Confirm Email Date of Birth* Month Day Year What is your resident status?* US citizen with valid ID US permanent resident ("green card") Valid Work Authorization Permit & Driver's license Foreign National with valid passport and Visa (no B1, B2. L1, F1 visas are eligible for this program) Other Other resident status*List information about your resident status. Where did you attend school?* In the United States Not in the United States What would you like to study?* ESL/ELA: Learning the English Language GED/Basic Skills: Preparing for the GED/HiSET and learning basic skills Where would you like to study?* Banks County Barrow County Dawson County Forsyth County Hall County Jackson County Lumpkin County Have you studied with us before?* Yes No What age are you at this time?* Under the age of 16 Age 16 or 17 18 or Above Where did you learn about Lanier Tech’s Adult Education program? (Check all that apply) Online advertisement YouTube or Podcast Flyer or brochure Friend or family member Walk-In Radio or television Newsletter or magazine advertisement Other Are you interested in any of these careers? (Check all that apply) Healthcare Education Manufacturing Automotive Welding Other Since you are currently under the age of 16 you are not eligible to participate in our program. Please check back with us after you have turned 16.We strongly encourage students currently enrolled in high school to not drop out. Finishing a high school diploma is always the best course of action. Previous Student InformationHighest School Grade Attended:--Select One--No formal schooling1st grade2nd grade3rd grade4th grade5th grade6th grade7th grade8th grade9th grade10th grade11th grade12th gradeHighest award/degree earned:--Select One--NoneHS DiplomaHS Equivalency (HiSET, GED, etc.)Certificate of Attendance/CompletionSome Postsecondary EducationTechnical/VocationalAssociate’s DegreeBachelor’s DegreeMaster’s DegreeSpecialist’s DegreeDoctorate’s DegreeUnknownDid you attend school in the U.S.A or another country? U.S.A Other Country I have not ever attended school Labor Status: Employed Full Time Employed Part Time Employed, but I have received a notice of termination, facility closure, or I am a transitioning service member. Unemployed and looking for work Not working and not looking for work (Homemaker, retiree, student) Have you or someone in your household received any of the following in the last six months? Temporary Assistance for Needy Families (TANF) Have you received TANF for more than two years in total? Supplemental Nutrition Assistance Program (SNAP), “food stamps” Supplemental Security Income (SSI) State or local income-based public assistance None of the above Select AllHow many family members, including yourself, have lived in your household in the last six months? 1 2 3 4 5 6 7 8 9 10 or more Under the age of 16Since you are currently under the age of 16 you are not eligible to participate in our program. Please check back with us after you have turned 16.General Release FormI, the undersigned, hereby give Lanier Technical College (LTC) of the Technical College System of Georgia (TCSG), its licensees, successors, legal representatives, and assigns the absolute and irrevocable right and permission to use my name and to use, reproduce, edit, exhibit, project, display, copyright, and publish sound recordings, photographic images or videos of me in which I may be included in whole or in part, recorded or photographed, and thereafter, and to circulate the same in all forms and media for art, advertising, trade, and/or any other lawful purpose whatsoever. I also consent to the use of any printed matter in conjunction therewith. I hereby waive any right that I may have to inspect and/or approve the finished product or products or the editorial, advertising, or printed copy that may be used in connection therewith and any right that I may have to control the use to which said product, products, or printed copy may be applied. I further waive any right to royalties or other compensation arising from or related to the use of my image or name. I hereby waive all claims to compensation or damages based on the use of my image by "LTC", its licensees, successors, legal representatives, and assigns. I hereby release, discharge and agree to hold harmless "LTC", its licensees, successors, legal representatives and assigns from any liability by virtue of any blurring, distortion, alteration, optical illusion or use in composite form whether intentional or otherwise that may occur or be produced in the making, processing, duplication, projecting or displaying of said picture, image, or recording. I further release, discharge and agree to hold "LTC", its licensees, successors, legal representatives and assigns from all claims, demands, rights and causes of action of whatever kind of nature, arising from or by reason of any and all injuries, damages and the consequences thereof resulting from the use of my name and likeness, including without limitation any and all claims from invasion of privacy or rights of publicity. I HEREBY CERTIFY THAT I, suffering under no legal disabilities, that I have read the above carefully before signing and fully understand its contents. This release shall be binding upon me and my heirs, legal representatives and assigns.Minor Consent* I am the parent and guardian of the minor named herein, and have the legal authority to execute the above release. I approve the foregoing and waive any rights in the premises. I do not consent. (You must send a dated letter to AEAdmissions@laniertech.edu with the parent’s/guardian’s signature and the signature of the underage student stating to what specifically you do not consent. Otherwise, we will assume you have provided consent.) Parent or Guardian Signature*Date* MM slash DD slash YYYY Student's Signature*Date* MM slash DD slash YYYY Release of InformationI am the parent and guardian of the minor named herein, and have the legal authority to execute the above release. I give permission to release any demographic, test history, attendance, performance, and other program information to me, the minor named herein, and to the organizations or individuals I list below. Note: If you have additional family members or individuals you want to have access to this information, please list them by name. If you need information to be released to the Department of Community Services, the court system, the Department of Labor, or the local workforce development board, please list those organizations here as well.I give permission to release any demographic, test history, attendance, performance, and other program information to me and to the organizations or individuals I list below. Note: If you have additional family members or individuals you want to have access to this information, please list them by name. If you need information to be released to the Department of Community Services, the court system, the Department of Labor, or the local workforce development board, please list those organizations here as well.List who you give permission to release information to.Parent or Guardian Signature*Date* MM slash DD slash YYYY Student's Signature*Date* MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.